Treadmill training for patients with Parkinson's disease

Background Treadmill training is used in rehabilitation and is described as improving gait parameters of patients with Parkinson's disease. Objectives To assess the effectiveness of treadmill training in improving the gait function of patients with Parkinson's disease and the acceptability and safety of this type of therapy. Search strategy We searched the Cochrane Movement Disorders Group Specialised Register (see Review Group details for more information) (last searched March 2009), Cochrane Central Register of Controlled Trials (The Cochrane Library 2009, Issue 2), MEDLINE (1950 to March 2009), and EMBASE (1980 to March 2009). We also handsearched relevant conference proceedings, searched trials and research registers, and checked reference lists (last searched March 2009). We contacted trialists, experts and researchers in the field and manufacturers of commercial devices. Selectioncriteria We included randomised controlled trials comparing treadmill training with no treadmill training in patients with Parkinson's disease. Data collection and analysis Two review authors independently selected trials for inclusion, assessed trial quality and extracted data. We contacted the trialists for additional information. We analysed the results as standardised mean differences (SMDs) and mean differences (MDs) for continuous variables and relative risk differences (RD) for dichotomous variables. Main results We included eight trials (203 participants) in this review. Treadmill training improved gait speed (SMD 0.50; 95% confidence interval (CI) 0.17 to 0.84; P = 0.003; I-2 = 0%) (fixed-effect model), stride length (SMD 0.42; 95% CI 0.00 to 0.84; P = 0.05; I-2 = 0%), walking distance (MD = 358 metres; 95% CI 289 to 426; P < 0.0001; I-2 = 30%), but cadence did not improve (MD 1.06; 95% CI 4.32 to 6.44; P = 0.70; I-2 = 0%) at the end of study. Treadmill training did not increase the risk of patients dropping out (RD -0.07; 95% CI -0.18 to 0.05; P = 0.26; I-2 = 51%) (random-effects model). Adverse events were not reported. Authors' conclusions Patients with Parkinson's disease who receive treadmill training are more likely to improve their impaired gait hypokinesia. However, the results must be interpreted with caution because there were variations between the trials in patient characteristics, the duration and amount of training, and types of treatment. Additionally, it is not known how long these improvements may last.